New state rule shuffles nurse practitioner practices

JACKSON – A new rule for physicians working with nurse practitioners will have some nurses and hospitals scrambling over the next month to comply.
“Our members are very concerned that they will not be able to continue to provide services to their patients,” said Nurse Practitioner Gayle Harrell, president of the Mississippi Nurses’ Association, who noted many other states are removing restrictions on advance practice nurses.
After two hearings and two years of work, the Mississippi Board of Medical Licensure on Tuesday published the new regulation which restricts the number of advance practice nurses – nurse practitioners, nurse midwives and nurse anesthetists – a physician can work with and sets guidelines for how closely the physicians should work with them. The rule will go into effect April 25.
“This was very carefully considered,” said Dr. Van Craig, executive director of the licensure board. “We’re not interested in restricting access to care in the state of Mississippi.… We want it to be safe.”
Many hospitals rely on advance practice nurses to staff intensive care, neonatal intensive care and obstetrical units, Combs said. Rural hospitals often lean on nurse practitioners in emergency departments.
“We’re encouraging our hospitals to dig in right away,” said Gwen Combs, vice president of policy for the Mississippi Hospital Association, so they can figure out how they need to adjust schedules and where they need to apply for waivers. “It’s going to be very challenging.”
The rule
Under the new rule – which does allow for case-by-case waivers – the physician collaborator must be within 40 miles of the nurse’s practice – the previous geographic boundary was 15 miles.
It also requires that physicians serve as the primary collaborator for no more than four nurses at a time; the physician also can serve as a secondary collaborator for up to four nurses.
In acute care settings, like hospitals, the collaborating physician must see the patient within 12 hours of the patient being examined by the advance practice nurse.
The rule is designed to make sure physicians can provide adequate support and participation in the quality assurance program designed with the Mississippi Board of Nursing, Craig said.
The Mississippi State Medical Association supports the ruling as a safety measure, said association president-elect Dr. James Rish, a Tupelo pulmonologist.
“We feel that it is unlikely that a physician can adequately meet the supervisory requirements for more than four nurse practitioners and maintain the quality of care our patients deserve,” said Rish, noting the State Board of Nursing is also in agreement with the licensure board regulations.
michaela.morris@journalinc.com